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KU Tobacco Cessation Expert Sees ‘Big Disparity In Who’s Smoking And Who’s Dying’

Dave Ranney
Heartland Health Monitor

Studies have shown that nearly half of the cigarettes consumed in the United States are smoked by people thought to have a mental illness.

At the same time, people who have a mental illness die an average of 25 years earlier than those who don’t have a mental illness.

“There’s a really big disparity in who’s smoking and in who’s dying,” said Kim Richter, who runs the tobacco cessation program at the University of Kansas Medical Center in Kansas City, Kan.

“And we as a society haven’t really done anything about this,” she said. “We really need to turn this around.”

Richter led a Saturday session, “Mental Illness & Tobacco Use: Why Do I Smoke and What Will Really Help Me?” during the National Alliance on Mental Illness-Kansas annual conference in Topeka.

“People tend to assume that people with serious mental illnesses are dying years earlier than the general population because of things like suicide or the side effects of homelessness,” Richter said. “But that’s not the case. They’re dying because of chronic conditions like diabetes or heart attacks or strokes or COPD (chronic obstructive pulmonary disease) or cancer, all of which are a direct result of tobacco use.”

Efforts to reduce smoking among people with mental illness, she said, have long been hamstrung by the perception — especially in the state’s medical community — that people can quit smoking if they really want to, and until they want to quit, cessation efforts are a waste of time.

“I think we forget how formidable tobacco is in people’s lives,” Richter said.

She asked the audience to realize that the average smoker takes 12 to 15 puffs per cigarette, which means that a pack-a-day smoker takes somewhere between 87,000 and 109,500 puffs in a year.

Richter said her average patient at the KU hospital has been smoking for 29 years.

Nicotine, she said, is incredibly addictive and cigarettes constitute “the best drug-delivery system that’s ever been created.”

Richter said surveys have found that most people who try to quit smoking take a “cold turkey” approach that doesn’t include counseling or cessation medication. These efforts, she said, typically have a 5 percent success rate.

For people with a mental illness, the success rate is between zero and 3 percent. “It’s very low,” Richter said.

But she said that success rate significantly improves when patients take advantage of cessation counseling and medications, most of which are now covered by private insurance, Medicaid and Veterans Affairs benefits.

“Chantix alone triples the odds of being able to quit,” Richter said, referring to the prescription drug that reduces craving for nicotine.

Health care professionals, she said, need to recognize that tobacco is an addictive substance and that successful cessation likely will require many attempts.

“We’ve got to stop blaming people for not quitting on the third, fourth or fifth time they try,” she said. “We’ve got to stick with them. The trick is … to use all the resources that are available and to make every quit attempt useful.”

Richter encouraged anyone who’s interested in finding out more about the resources that are available to call the state’s cessation hotline — 1-800-784-8669 — or talk with their health care provider.

Asked whether switching to e-cigarettes can help some people quit smoking, she replied: “The jury is still out on that one.”

Richter is an active member of a Kansas Health Foundation-funded fellows program that is looking for ways to help people with severe and persistent mental illness reduce their use of tobacco products.

Richter’s presentation struck a chord with Randy Selley, a 53-year-old resident of Wichita.

“I’m a smoker, have been for probably 30 years,” he said. “I’ve tried to quit before, many times. She’s right, people don’t realize how hard it is to quit.”

Selley, who said he has schizoaffective disorder, said he may try to quit smoking again.

“I’m not ready,” Selley said. “I might someday, but not now. Smoking makes me feel better. After I smoke about half a cigarette, it relieves my anxiety. My racing thoughts calm down.”

Dave Ranney is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.

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